<div class="span8">
    <legend>Nạp điểm từ thẻ cào</legend>
    
        
        
        
    
    <form method="post" class="form-horizontal">
        <div class="control-group">
            <label class="control-label">Loại thẻ</label>
            <div class="controls">
                <select id="cardselect" class="span2" name="cardtype">
                    <option value="0">Chọn</option>
                    <option value="VMS">Mobifone</option>
                    <option value="VNP">Vinaphone</option>
                    <option value="VTT">Viettel</option>
                    <option value="VTC">VTC Vcoin</option>
                    <option value="FPT">FPT Gate</option>
                    <option value="MGC">Megacard</option>
                </select>
                <p style="color: #953B39;" id="card-msg" class="help-block hide"></p>
            </div>
        </div>
        <div class="control-group">
            <label class="control-label">Số trên thẻ</label>
            <div class="controls">
                <input type="text" autocomplete="off" maxlength="15" value="" name="cardnumber" class="input-xlarge">
                <p class="help-block">Vui lòng không dùng ký tự - hoặc khoảng trắng</p>
            </div>
        </div>
        <div class="control-group card-serial-control">
            <label class="control-label">Mã số serial</label>
            <div class="controls">
                <input type="text" autocomplete="off" value="" name="cardserial" class="input-xlarge">
   
            </div>
        </div>
        
        <div class="control-group card-serial-control">
            <label class="control-label"></label>
            <div class="controls">
                <button class="btn btn-inverse">Thực hiện nạp điểm</button>
            </div>
        </div>
    </form>
        
    <table class="table table-bordered table-heading">
        <thead>
            <tr class="heading">
                <th style="text-align: right;">Mệnh giá (VND)</th>
                <th style="text-align: right;">Điểm quy đổi</th>
                <th style="text-align: right;">Khuyến mãi</th>
                <th style="text-align: right;">Lần nạp đầu tiên</th>
            </tr>
        </thead>
        <tbody>
                        <tr>
                <td style="text-align: right;">10,000</td>
                <td style="text-align: right;">10.00 điểm</td>
                <td style="text-align: right;">
                                    </td>
                <td style="text-align: right;">
                                        <span class="label label-success pull-left">+10%</span> <span class="label">1.00</span>
                                    </td>
            </tr>
                        <tr>
                <td style="text-align: right;">20,000</td>
                <td style="text-align: right;">20.00 điểm</td>
                <td style="text-align: right;">
                                    </td>
                <td style="text-align: right;">
                                        <span class="label label-success pull-left">+10%</span> <span class="label">2.00</span>
                                    </td>
            </tr>
                        <tr>
                <td style="text-align: right;">50,000</td>
                <td style="text-align: right;">50.00 điểm</td>
                <td style="text-align: right;">
                                    </td>
                <td style="text-align: right;">
                                        <span class="label label-success pull-left">+10%</span> <span class="label">5.00</span>
                                    </td>
            </tr>
                        <tr>
                <td style="text-align: right;">100,000</td>
                <td style="text-align: right;">100.00 điểm</td>
                <td style="text-align: right;">
                                    </td>
                <td style="text-align: right;">
                                        <span class="label label-success pull-left">+15%</span> <span class="label">15.00</span>
                                    </td>
            </tr>
                        <tr>
                <td style="text-align: right;">200,000</td>
                <td style="text-align: right;">200.00 điểm</td>
                <td style="text-align: right;">
                                    </td>
                <td style="text-align: right;">
                                        <span class="label label-success pull-left">+15%</span> <span class="label">30.00</span>
                                    </td>
            </tr>
                        <tr>
                <td style="text-align: right;">300,000</td>
                <td style="text-align: right;">300.00 điểm</td>
                <td style="text-align: right;">
                                    </td>
                <td style="text-align: right;">
                                        <span class="label label-success pull-left">+15%</span> <span class="label">45.00</span>
                                    </td>
            </tr>
                        <tr>
                <td style="text-align: right;">500,000</td>
                <td style="text-align: right;">500.00 điểm</td>
                <td style="text-align: right;">
                                    </td>
                <td style="text-align: right;">
                                        <span class="label label-success pull-left">+25%</span> <span class="label">125.00</span>
                                    </td>
            </tr>
                        <tr>
                <td style="text-align: right;">1,000,000</td>
                <td style="text-align: right;">1,000.00 điểm</td>
                <td style="text-align: right;">
                                    </td>
                <td style="text-align: right;">
                                        <span class="label label-success pull-left">+25%</span> <span class="label">250.00</span>
                                    </td>
            </tr>
                    </tbody>
    </table>
    
</div>